Fulminant ascending paralysis as a delayed sequela of diethylene glycol (Sterno) ingestion

Abstract

The authors report a 57-year-old man who survived 18 days after swallowing an 8-oz. can of Sterno in a suicide attempt. Two days after ingestion, he developed confusion and acute renal failure requiring hemodialysis, followed on day 8 by a delayed but rapidly evolving ascending paralysis. Pathologic examination showed severe demyelination, with lesser axonal damage, of virtually all cranial and peripheral nerves sampled and sparing of central myelin. The diethylene glycol in the Sterno was considered responsible for this intoxication.

Alcohol-induced changes in the brain as assessed by MRI and CT

“…As with methanol, accidental (or suicidal) ingestion of ethylene glycol can occur due to its colourless and nearly odourless properties, resulting in severe metabolic acidosis. Severe systemic and neurological complications occur approximately 12 h after ingestion, leading to hepatorenal failure, brain oedema with coma, seizures and peripheral neuropathy [68,69]. Brain oedema can be seen early on CT and MR; however, necrosis of the white matter, predominantly in the frontal lobe, basal ganglia, thalami, midbrain and upper pons, seen as hypodense areas on CT and hypo T1/hyper T2 signal changes on MR, will develop after 24-48 h and may disappear after 5-35 days.…”

Diethylene Glycol: Widely Used Solvent Presents Serious Poisoning Potential

“…She received high-dose steroids and her neurologic function improved over time (13). Rollins et al described a similar course of neurologic toxicity after an intentional ingestion of DEG in a 56-year-old man (9). The patient was admitted to the hospital where he was initially asymptomatic.…”

“…EMG/NCV studies on day 13 showed severe neuropathy with demyelinating features. Support was withdrawn and the patient expired approximately 18 days after ingestion (9).…”

Delayed autonomic neuropathy in a patient with diethylene glycol poisoning: a case report

“…The reason why there has been no report of autonomic neuropathy in DEG intoxication is partly because few cases can survive from severe delayed neuropathy in DEG intoxication 3, 4. Rapid‐progressing fatal paralysis and brain atrophy, edema, and infarction, which might be irreversible, were also reported 2, 8, 9. Therefore, the high mortality rate of severe neurological complications might conceal an existence of autonomic neuropathy in DEG poisoning.…”

“…Diethylene glycol intoxication is marked by gastrointestinal symptoms and hepatorenal injury in the acute phase and delayed neurological complications with evidence of peripheral demyelination that causes quadriparesis and ventilator dependence in severe cases 1, 2, 3, 4. However, autonomic neuropathy in DEG poisoning has never been reported.…”